<s>
Learning	B-General_Concept
health	I-General_Concept
systems	I-General_Concept
(	O
LHS	O
)	O
are	O
health	O
and	O
healthcare	O
systems	O
in	O
which	O
knowledge	O
generation	O
processes	O
are	O
embedded	O
in	O
daily	O
practice	O
to	O
improve	O
individual	O
and	O
population	O
health	O
.	O
</s>
<s>
The	O
need	O
to	O
close	O
this	O
gap	O
was	O
further	O
underscored	O
by	O
the	O
growth	O
of	O
electronic	B-Application
health	I-Application
records	I-Application
(	O
EHR	O
)	O
and	O
other	O
innovations	O
in	O
health	O
information	O
technology	O
and	O
computational	O
power	O
,	O
and	O
the	O
resulting	O
ability	O
to	O
generate	O
data	O
that	O
can	O
lead	O
to	O
better	O
evidence	O
and	O
better	O
outcomes	O
.	O
</s>
<s>
There	O
has	O
since	O
been	O
increasing	O
interest	O
in	O
the	O
topic	O
,	O
including	O
the	O
creation	O
of	O
the	O
Wiley	O
journal	O
Learning	B-General_Concept
Health	I-General_Concept
Systems	I-General_Concept
.	O
</s>
<s>
"	O
big	B-Application
data	I-Application
"	O
for	O
use	O
in	O
research	O
;	O
</s>
<s>
a	O
learning	B-General_Concept
health	I-General_Concept
system	I-General_Concept
as	O
"	O
a	O
health	O
system	O
in	O
which	O
internal	O
data	O
and	O
experience	O
are	O
systematically	O
integrated	O
with	O
external	O
evidence	O
,	O
and	O
that	O
knowledge	O
is	O
put	O
into	O
practice	O
.	O
</s>
<s>
Among	O
several	O
early	O
publications	O
to	O
express	O
the	O
need	O
for	O
a	O
rapid	O
learning	B-General_Concept
health	I-General_Concept
system	I-General_Concept
was	O
a	O
commentary	O
in	O
Health	O
Affairs	O
in	O
2007	O
where	O
Lynn	O
Etheredge	O
applied	O
the	O
term	O
“	O
rapid	O
learning	B-General_Concept
health	I-General_Concept
system	I-General_Concept
”	O
in	O
recognition	O
of	O
the	O
opportunity	O
to	O
leverage	O
electronic	B-Application
health	I-Application
records	I-Application
(	O
EHR	O
)	O
to	O
“	O
learn	O
”	O
what	O
works	O
in	O
health	O
care	O
.	O
</s>
<s>
Some	O
refer	O
to	O
a	O
learning	O
healthcare	O
system	O
,	O
others	O
refer	O
to	O
learning	B-General_Concept
health	I-General_Concept
systems	I-General_Concept
or	O
collaborative	O
learning	O
health	O
networks	O
.	O
</s>
<s>
The	O
Veterans	O
Administration	O
Health	O
System	O
,	O
Group	O
Health	O
Cooperative	O
,	O
Kaiser	O
Permanente	O
and	O
Geisinger	O
Health	O
System	O
were	O
among	O
the	O
vanguard	O
organizations	O
who	O
also	O
published	O
insights	O
from	O
their	O
experience	O
of	O
launching	O
formal	O
learning	B-General_Concept
health	I-General_Concept
system	I-General_Concept
activities	O
.	O
</s>
<s>
Easterling	O
and	O
colleagues	O
(	O
REF	O
LHS	O
2022	O
)	O
proffer	O
an	O
elaborate	O
taxonomy	O
of	O
LHS	O
elements	O
and	O
use	O
this	O
to	O
describe	O
an	O
LHS-IP	O
,	O
or	O
“	O
Learning	B-General_Concept
Health	I-General_Concept
System	I-General_Concept
In	O
Practice	O
”	O
as	O
a	O
model	O
for	O
health	O
care	O
systems	O
who	O
seek	O
to	O
become	O
an	O
LHS	O
.	O
</s>
<s>
Dissemination	O
of	O
the	O
activities	O
and	O
experiences	O
of	O
learning	B-General_Concept
health	I-General_Concept
systems	I-General_Concept
has	O
been	O
an	O
instrumental	O
aspect	O
of	O
their	O
growth	O
and	O
spread	O
.	O
</s>
<s>
While	O
peer-reviewed	O
literature	O
on	O
the	O
LHS	O
appears	O
in	O
a	O
variety	O
of	O
journals	O
,	O
the	O
creation	O
of	O
Healthcare	O
:	O
the	O
Journal	O
of	O
Delivery	O
Science	O
and	O
Innovation	O
and	O
the	O
Learning	B-General_Concept
Health	I-General_Concept
Systems	I-General_Concept
Journal	O
are	O
dedicated	O
to	O
manuscripts	O
that	O
showcase	O
the	O
experience	O
of	O
those	O
deploying	O
or	O
refining	O
aspects	O
of	O
learning	O
in	O
real-world	O
practices	O
.	O
</s>
<s>
A	O
large	O
proportion	O
of	O
LHS	O
research	O
relies	O
on	O
the	O
use	O
of	O
electronic	B-Application
health	I-Application
records	I-Application
(	O
EHRs	B-Application
)	O
and	O
must	O
navigate	O
the	O
inherent	O
challenges	O
of	O
EHRs	B-Application
.	O
</s>
<s>
EHRs	B-Application
were	O
primarily	O
created	O
to	O
support	O
billing	O
for	O
clinical	O
services	O
and	O
tracking	O
health	O
insurance	O
claims	O
.	O
</s>
<s>
Clinical	B-Application
decision	I-Application
support	I-Application
systems	I-Application
use	O
patient	O
algorithms	O
applied	O
to	O
patient	O
data	O
to	O
make	O
specific	O
treatment	O
recommendations	O
.	O
</s>
<s>
A	O
Chicago	O
Center	O
of	O
Excellence	O
in	O
Learning	B-General_Concept
Health	I-General_Concept
Systems	I-General_Concept
Research	O
Training	O
(	O
ACCELERAT	O
)	O
,	O
Northwestern	O
University	O
,	O
Chicago	O
,	O
Ill	O
.	O
</s>
<s>
CATALyST	O
:	O
Consortium	O
for	O
Applied	O
Training	O
to	O
Advance	O
the	O
Learning	B-General_Concept
Health	I-General_Concept
System	I-General_Concept
with	O
Scholars/Trainees	O
,	O
Kaiser	O
Permanente	O
Washington	O
Research	O
Institute	O
,	O
Seattle	O
,	O
WA	O
.	O
</s>
<s>
Learning	B-General_Concept
Health	I-General_Concept
System	I-General_Concept
Scholar	O
Program	O
at	O
Vanderbilt	O
,	O
Vanderbilt	O
University	O
,	O
Nashville	O
,	O
Tenn	O
.	O
</s>
<s>
Leveraging	O
Infrastructure	O
to	O
Train	O
Investigators	O
in	O
Patient-Centered	O
Outcomes	O
Research	O
in	O
Learning	B-General_Concept
Health	I-General_Concept
System	I-General_Concept
(	O
LITI	O
-	O
PCORLHS	O
)	O
,	O
Indiana	O
University	O
School	O
of	O
Medicine	O
,	O
Indianapolis	O
,	O
Ind	O
.	O
</s>
<s>
Minnesota	O
Learning	B-General_Concept
Health	I-General_Concept
System	I-General_Concept
Mentored	O
Career	O
Development	O
Program	O
(	O
MN-LHS	O
)	O
,	O
University	O
of	O
Minnesota	O
,	O
Minneapolis	O
,	O
Minnesota	O
.	O
</s>
<s>
Northwest	O
Center	O
of	O
Excellence	O
&	O
K12	O
in	O
Patient	O
Centered	O
Learning	B-General_Concept
Health	I-General_Concept
Systems	I-General_Concept
Science	O
,	O
Oregon	O
Health	O
and	O
Science	O
University	O
,	O
Portland	O
,	O
Oregon	O
.	O
</s>
<s>
University	O
of	O
California-San	O
Francisco	O
Learning	B-General_Concept
Health	I-General_Concept
System	I-General_Concept
K12	O
Career	O
Development	O
Program	O
,	O
University	O
of	O
California	O
San	O
Francisco	O
,	O
San	O
Francisco	O
,	O
California	O
.	O
</s>
<s>
The	O
Patient-Centered	O
Outcomes	O
Research	O
Institute	O
(	O
PCORI	O
)	O
has	O
designated	O
the	O
realization	O
of	O
a	O
national	O
learning	B-General_Concept
health	I-General_Concept
system	I-General_Concept
as	O
one	O
of	O
their	O
five	O
national	O
priorities	O
for	O
health	O
,	O
which	O
is	O
indicative	O
of	O
future	O
funding	O
opportunities	O
.	O
</s>
<s>
In	O
this	O
way	O
,	O
learning	B-General_Concept
health	I-General_Concept
system	I-General_Concept
may	O
be	O
distinguished	O
from	O
traditional	O
health	O
services	O
or	O
informatics	O
research	O
and	O
more	O
closely	O
resemble	O
the	O
funding	O
and	O
infrastructure	O
that	O
health	O
systems	O
designate	O
for	O
quality	O
improvement	O
activities	O
.	O
</s>
<s>
Bioethics	O
scholars	O
including	O
Faden	O
,	O
Asch	O
,	O
Finkelstein	O
,	O
Morain	O
,	O
and	O
Platt	O
have	O
averred	O
that	O
in	O
a	O
learning	B-General_Concept
health	I-General_Concept
system	I-General_Concept
,	O
consideration	O
should	O
be	O
given	O
to	O
both	O
clinical	O
ethics	O
and	O
research	O
ethics	O
.	O
</s>
<s>
Faden	O
,	O
Kass	O
and	O
colleagues	O
have	O
put	O
forth	O
an	O
ethics	O
framework	O
for	O
the	O
learning	B-General_Concept
health	I-General_Concept
system	I-General_Concept
that	O
is	O
anchored	O
on	O
seven	O
essential	O
obligations	O
:	O
(	O
1	O
)	O
respecting	O
dignity	O
and	O
rights	O
of	O
all	O
patients	O
;	O
(	O
2	O
)	O
respecting	O
clinical	O
judgment	O
;	O
(	O
3	O
)	O
providing	O
optimal	O
care	O
to	O
every	O
patient	O
;	O
(	O
4	O
)	O
avoiding	O
the	O
introduction	O
of	O
non-clinical	O
burdens	O
and	O
risks	O
;	O
(	O
5	O
)	O
reducing	O
health	O
inequities	O
;	O
(	O
6	O
)	O
ensuring	O
responsible	O
activities	O
are	O
conducted	O
in	O
a	O
way	O
that	O
fosters	O
learning	O
;	O
and	O
(	O
7	O
)	O
contributing	O
to	O
the	O
overall	O
aim	O
of	O
improving	O
quality	O
and	O
value	O
in	O
health	O
care	O
.	O
</s>
